Combining medication with psychoeducational therapy, especially in a family or group format, is more effective at preventing episode recurrence in adults and adolescents with bipolar disorder than medication alone. Researchers published the findings, from a systematic review and network meta-analysis, online in JAMA Psychiatry.
The investigation included 39 randomized controlled trials spanning 3863 participants receiving medication for bipolar disorder. Patients were randomly assigned to an active family, individual, or group therapy intervention or to usual care consisting of medication with routine monitoring and support from a psychiatrist. Patients were followed for 12 months.
According to the study, psychoeducation with guided practice of illness management skills, such as how to keep regular sleep-wake cycles, in a family or group format was associated with reducing recurrences of mania and depressive symptoms, compared with the same strategies taught in an individual therapy format. Moreover, cognitive behavioral therapy, family therapy, and interpersonal therapy were associated with better stabilization of depressive symptoms compared with usual care.
Acceptability of treatment, as reflected in study retention, was also higher in patients who received family-oriented therapies.
Lead author David Miklowitz, PhD, a distinguished professor of psychiatry at the University of California - Los Angeles Health Sciences, said the findings point to the importance of a support system for patients.
“Not everyone may agree with me, but I think the family environment is very important in terms of whether somebody stays well,” Dr. Miklowitz said. “There’s nothing like having a person who knows how to recognize when you’re getting ill and can say, ‘You’re starting to look depressed or you’re starting to get ramped up.’ That person can remind their loved one to take their medications or stay on a regular sleep-wake cycle or contact the psychiatrist for a medication evaluation.”
Patients without close relatives can glean similar support through group therapy, he pointed out.
“If you’re in group therapy, other members of that group may be able to help you recognize that you’re experiencing symptoms,” Dr. Miklowitz said. “People tend to pair off. It’s a little bit like the AA model of having a sponsor.”
Miklowitz D, Efthimiou O, Furukawa T, et al. Adjunctive psychotherapy for bipolar disorder: a systematic review and component network meta-analysis. JAMA Psychiatry. 2020 October 14;[Epub ahead of print].